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Quote from KFF President and CEO Drew Altman reads, "when it comes to the “affordability crisis” driving the national discussion of health care today, the chronically ill, and most of all the chronically ill uninsured, are the tip of the spear."

The Group that Struggles the Most in American Health Care

In a new column, Dr. Drew Altman, KFF’s Founding President and CEO, previews findings about the chronically ill uninsured from a large KFF survey of 25,000 Americans focusing on the cost and access challenges facing the chronically ill, which will be released tomorrow. He writes: “There are more than enough needs to go around in American health care, but if I had to pick the one group that struggles the most with costs and access, it would be people with chronic illnesses who are also uninsured.”

Other “Beyond the Data” columns >>

Key Facts about the Uninsured Population

The number and share of people without insurance grew in 2024, increasing for the first time since 2019, according to KFF’s analysis of data from the American Community Survey (ACS). This issue brief describes trends in health coverage in 2024, examines the characteristics of the uninsured population , and summarizes the access and financial implications of not having coverage.

Data and analysis

The coverage gap exists because some states did not expand Medicaid under the ACA to cover adults under age 65 without dependent children with incomes at/below 138% of the federal poverty level (FPL)

How Many Uninsured Are in the Coverage Gap?

An estimated 1.4 million uninsured individuals in the 10 states without Medicaid expansion, including many working adults, people of color, and those with disabilities, remain in the "coverage gap," ineligible for Medicaid or for ACA tax credits that would make coverage affordable.

The Uninsured and Health Coverage

This Health Policy 101 chapter examines the share of the United States population who are uninsured, highlighting their demographics and the challenges they face because of the lack of coverage.

Key Facts on Health Coverage of Immigrants

This fact sheet provides an overview of health coverage for immigrants based on data from the 2023 KFF/LA Times Survey of Immigrants. As of 2023, half of likely undocumented immigrant adults and one in five lawfully present immigrant adults reported being uninsured.

Who was uninsured in 2024?

Latest Polling
9.8%

The share of people under age 65 without insurance
62%

The share of uninsured adults who said they were uninsured because coverage is not affordable
59%

The share of uninsured adults who said they or someone living with them had problems paying for health care
39%

The share of uninsured adults who reported delaying or not getting needed care or medication due to cost
Other key facts about the uninsured >>

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  • New Incentive for States to Adopt the ACA Medicaid Expansion: Implications for State Spending

    Issue Brief

    The American Rescue Plan Act of 2021 encourages non-expansion states to take up the expansion by providing an additional temporary fiscal incentive for states to newly implement the ACA Medicaid expansion. This brief provides illustrative estimates of the net fiscal benefit to states from these incentives relative to state costs under the expansion.

  • Key Facts about the Uninsured Population

    Issue Brief

    The number and share of people without insurance grew in 2024, increasing for the first time since 2019, according to KFF's analysis of data from the American Community Survey (ACS). This issue brief describes trends in health coverage in 2024, examines the characteristics of the uninsured population , and summarizes the access and financial implications of not having coverage.

  • Medicare: Comparison of the Candidates’ Proposals

    Fact Sheet

    Medicare: Comparison of Candidate's Proposals Download a printable pdf of this document Bush-Cheney1 Kerry-Edwards2 General approach Supports greater role for private plans under Medicare to give seniors greater choice of health plans. Supports giving seniors a choice of a health plan that’s right for them. Opposes privatization of Medicare that causes benefit cutbacks. Opposes forcing seniors into HMOs to get drug benefits or affordable premiums. Market competition Supports competition between Medicare private plans and the…

  • YouToons: Health Insurance Explained

    Health Insurance Explained: The YouToons Have it Covered

    Video

    In this five-minute animated video, the YouToons help consumers understand their health insurance through fun, easy-to-understand explanations and scenarios. This cartoon serves as a tutorial for consumers and organizations. The YouToons previously appeared in the 2010 animated movie, "Health Reform Hits Main Street" and the 2013, "The YouToons Get Ready for Obamacare: Health Insurance Changes Coming Your Way Under the Affordable Care Act."

  • Bar chart shows the estimated 10-year federal spending reductions from delaying implementation of the Biden administration's Medicare Savings Program rule and the Eligibility and Enrollment rule. Delaying these two Medicaid eligibility rules will cut federal spending by $122 billion and increase the uninsured by 400,000 over ten years

    The Impact of H.R. 1 on Two Medicaid Eligibility Rules

    Issue Brief

    This issue brief describes the impact of H.R.1's 10-year delay in implementing provisions in two Medicaid eligibility rules that would have reduced red tape. The delayed rules are projected to decrease federal spending and future Medicaid and CHIP enrollment and increase coverage loss.

  • President Trump’s Record on Health Care

    Issue Brief

    This issue brief provides a detailed overview of the Trump Administration’s record on health care issues relating to: the Administration’s response to the COVID-19 pandemic, the ACA and private insurance markets, Medicaid, Medicare, reducing prescription drug and other health care costs, sexual and reproductive health, mental health and substance use, immigration and health, long-term care, HIV/AIDS policy, and LGBTQ health.

  • Do State Decisions to Prioritize Renewals for Medicaid Enrollees Who are Likely Ineligible Affect Early Disenrollment Rates?

    Policy Watch

    Some states are prioritizing Medicaid renewals for enrollees flagged as likely to be ineligible. Early data from Arizona, Idaho, and Pennsylvania show disenrollment rates for flagged enrollees are higher than for other enrollees. This analysis considers why different state approaches to renewals may explain some – but not all – variation in disenrollment rates across the U.S.

  • ACA Marketplace Survey Feature Image - Website

    Cost Concerns and Coverage Changes: A Follow-Up Survey of ACA Marketplace Enrollees

    Poll Finding

    This KFF survey is a follow-up survey of adults who had ACA Marketplace insurance in 2025. The survey examines the cost concerns and coverage changes that these 2025 Marketplace enrollees are experiencing following the expiration of the enhanced premium tax credits. The survey finds that half of returning enrollees say their health care costs are “a lot higher” and most expect to cut back on basic household expenses to afford coverage.

  • Health Insurance Coverage in America, 2010

    Report

    Over 49 million people in the United States had no health insurance coverage in 2010—more than one in every six (18.5%) of the population under age 65. Having a clear picture of who the uninsured are is fundamental to addressing this nation-wide problem. This slideshow provides figures and tables on the uninsured and health insurance coverage for the following subpopulations: nonelderly, children, nonelderly adults and working adults. Figures are provided for important social, economic, and…